Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes inpost-cardiac arrest care with targeted temperature management.

        目标体温管理的心肺复苏后的患者血流动力学变量与院内死亡率及良好神经预后的关系

        PURPOSE

        Although hemodynamic instability is expected during thepost-cardiac arrest period, the implications of hemodynamic parameters for outcomes remain unclear. Each phase of targeted temperature management (TTM) affects hemodynamic responses differently. This study aims to investigate the association of hemodynamic parameters with outcomes in patients receiving TTM after cardiac arrest.

        目的：虽然心脏骤停复苏后常会出现血流动力学不稳定，但血流动力学指标的影响仍不清楚。在目标体温管理(TTM)的每个阶段对血流动力学的反应也不同。本研究旨在探讨心脏骤停复苏后接受TTM患者的血流动力学参数与临床结局的关系。

        METHODS

        The study prospectively enrolled patients who were treated with TTM (33°C for 24h) after cardiac arrest. We assessed clinical and hemodynamic variables at pre-specified time points in survivors and non-survivors as well as among those with favorable vs. poor neurologic outcomes at discharge.

        方法：这项前瞻性研究纳入了心脏停搏复苏后接受TTM (33 °C持续24小时)的患者。针对幸存者和非幸存者、以及那些出院时存在有利与不利神经功能预后的患者，我们选择特定的时间点评估临床和血流动力学参数。

        RESULTS

        The study analyzed the records of 95 patients who completed TTM; at discharge 54 (57%) were alive and 21 (22%) had favorable neurological outcomes. Heart rate(HR) at 24h>93/min, cardiac index (CI) at 12h<2.5liter/min/m2and lower average of mean arterial blood pressure(MAP) at 36h and 48h were independently associated with in-hospital mortality (P<0.05 by Cox regression analysis respectively). MAP at 48h between 84 to 110mm Hg and lower HR at 48h were significantly associated with better neurological outcome at discharge (P<0.05 for by logistic regression analysis respectively).

        结果：研究分析了95 例完成TTM的患者; 出院时54例(57%)存活，21例(22%)获得有利的神经系统结局。在24 h时心率> 93次/min，在12h时心脏指数 (CI) <2.5 L/min/m2 以及在36 h 和48 h时平均动脉血液压(MAP)更低与院内死亡率独立相关 (P值均< 0.05)。在48 h时MAP84 -110 mmHg、更低的心率与出院时更好地神经功能预后显著相关 (P 值均< 0.05)。

        CONCLUSIONS

        Our results indicate that lower MAP and HR more than 93/min are associated with in-hospital mortality during the initial 48hours after ROSC. CI at 12h<2.5liter/min/m2is associated with survival but not with neurological outcome. During the course ofpost-cardiac arrest TTM, these markers of hemodynamic status may be useful predictors of outcomes.

        结论：我们的研究结果表明，在ROSC后最初的48小时内，MAP更低、HR大于93次/min与院内死亡率相关。在12h时CI <2.5L/min/m2 与存活率相关，但与神经功能预后不相关。在心脏骤停复苏后实行TTM过程中，这些表示血流动力学状态的指标对患者结局的预测可能是有用的。